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One in five children under the age of 17 has a mental disorder, according to the U.S. Centers for Disease Control and Prevention. Millions of young people have been diagnosed with conditions such as attention deficit hyperactivity disorder, depression, anxiety, and autism spectrum or bipolar disorders. These children and their families face many challenges, not the least of which is making sure they properly manage their treatment.

Studies suggest that treatment non-adherence is a major concern among children and adolescents. Not taking prescribed medications as directed can have serious consequences, including relapse and hospitalization.

“The goal of medications is to bring someone back to a stable mood state,” said David Miklowitz, PhD, a professor of psychiatry at the University of California-Los Angeles School of Medicine, who specializes in bipolar disorder. “It’s also to prevent the disorder from happening again, such as a manic episode in someone who’s bipolar.”

Why do so many young patients neglect their treatment, and what can families do to help them better manage their condition?

“Sometimes people will go off their medications because they feel better and think they’re cured,” said Miklowitz. “They still have an illness, and it can recur. People need to take the medications preventively so that doesn’t happen.”

Psychiatric medications, also known as psychotropic or psychotherapeutic drugs, affect brain chemicals related to behavior and mood. They include stimulants, antidepressants, mood stabilizers, anti-anxiety drugs and antipsychotics. Prescribing these drugs for younger patients is very tricky — many have not been studied in children, and their effects vary based on factors such as a child’s weight and age.

For patients like Natasha Tracy, “life-altering side effects can really make a person not want to be medication adherent.” It took two years after Tracy was diagnosed as bipolar for her to find a medication that didn’t have serious adverse effects. The most debilitating side effect, she recalls, was “massive daytime fatigue, where I would sleep 14 hours a day and wasn’t able to function.” Tracy, who now writes about her disorder online, also experienced nausea, dizziness, and a racing heartbeat.

"At some point you have to put a limit on the side effects you'll put up with for your health," said Tracy. "I had to work with my doctor to figure out what we could do, and what plan we could make to get me off the meds with side effects and onto something effective."

Drugs used to treat depression and anxiety — anti-depressants such as Prozac, Paxil, and Zoloft; and psychoactive drugs like Klonopin, Valium, and Xanax — share many common side effects. One of these, weight gain, “can be especially tough for kids,” according to Moira Rynn, MD, Interim Director of the Division of Child and Adolescent Psychiatry at Columbia University. “Doctors should take that side effect seriously.”

“Some kids say they feel better on the medication than they did before, and will exercise and change their diet to accommodate the side effects,” said Dr. Rynn. “Others don’t want to deal with it at all,” and stop taking the medication.

It’s important that young patients be monitored by a health care provider to ensure they’re sticking to their treatment and reporting any adverse effects. That means developing a trusting relationship with their doctor.

“If kids aren’t getting good follow-up care and can’t — or won’t — tell their doctor about side effects or other issues with medications, it’s unlikely they’ll stick with it,” said Rynn.

Many experts recommend children see a doctor every week or two when they’re first prescribed a drug. As the condition becomes more manageable, visits can be scheduled less frequently, and the doctor may adjust the medication or dosage accordingly.

Parents should monitor their child’s treatment adherence between doctor’s visits. The challenge is to not make your child feel like they’re under constant scrutiny.

“If kids feel like they’re being nagged or controlled, they’ll find ways to not take their medication,” Rynn said. “They might just flat-out refuse. For an 8-year-old, the one thing they might feel like they have control over is not taking a pill.”

Here are some things that parents can do to help kids manage treatment:

How hands-on a parent should be depends on the child’s age and the condition’s severity. All parents need to research a child’s disorder and be well informed about medications. A family member should be present at doctor’s appointments, and come prepared with questions for the health care provider.

If you detect changes in your child’s mood or behavior — such as sleeplessness, agitation, or seeming withdrawn — contact the doctor. Anti-depressants known as selective serotonin reuptake inhibitors (SSRIs), for instance, have been linked to an increased risk of suicidal thoughts or behavior in younger patients.

Rynn suggests using a pill dispenser to help parents tell at a glance if medications have been taken. Older children should be encouraged to keep a diary tracking what drugs they’ve taken when and any apparent effects.

Studies have shown that a combination of medication and psychotherapy can be most effective, and may reduce the amount of prescription drugs needed. Ask the doctor about behavioral therapy or other options that may help your child better cope with their condition and its management.

"If you're tempted to stop taking your medications, we encourage people to have a conversation with their doctor to see if something else can be done," said Miklowitz. "You might be able to change the dose or the medication. There are other options besides stopping."

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